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St. Joseph Hospital in Nashua redesigns emergency room to decrease wait times

By Staff | Apr 6, 2014

NASHUA – There’s a reason that St. Joseph Hospital didn’t build much of a waiting room into its new emergency department.

“We don’t want anyone waiting,” Dr. James Martin, medical director for the hospital’s Emergency Medical System, said during a tour of the department as construction crews scrambled with finishing touches.

It will open Tuesday after more than two years of planning and construction. A ribbon-cutting will be held Monday.

The design and technology of the 15,500-square-foot department aim to make it easier to handle more patients, cut the “door-to-provider” time that takes place between arrival and treatment, and speed up treatment and processes so patients can leave.

For example, the 20 acute-care rooms that ring the core facilities for clinical staff are largely identical, so they can handle almost anything that comes through the door with portable equipment, or necessary equipment that is duplicated, including cardiac monitors in every room.

“We will bring things to the patient rather than taking patient to specialized rooms,” said Karen Beinhaur, a registered nurse who is clinical director of emergency services for St. Joseph.

“If somebody comes in with a laceration, and there’s already (a patient) in the laceration/suture room, you won’t have to wait,” Martin said.

The two extra rooms and expected improved flow of patients will help during the busy times, which are par for the course in emergency departments.

“We’re full pretty often,” Beinhaur said. “With this, we won’t have to put patients in hallways.”

St. Joseph Hospital has been preparing to upgrade its 20-year-old emergency department for years.

In 2012, it shifted the physical therapy unit to a separate building on Northeastern Boulevard to make room for a temporary emergency department, and in June 2013, it shifted the emergency department to the temporary facility so the existing department could be gutted and rebuilt.

The process cost about $8 million, which includes moving costs, Martin said.

It’s a coincidence that the ribbon-cutting will occur just as the Affordable Care Act moves past its first big sign-up deadline, but the two events aren’t unconnected.

A big part of the effort to control health care costs involves shifting patients away from expensive emergency rooms when trauma or other critical care isn’t needed, yet St. Joseph Hospital hopes its new ER will attract more patients. The key will be to differentiate among patients who come in through the door, which isn’t always easy.

“Probably a majority of people (who come to an ER) don’t qualify as true emergencies, and that has been the case for decades,” Martin said.

It’s unclear what the effect of expanded health insurance through the Affordable Care Act will have. A Portland, Ore., study found that expanding Medicaid coverage actually increased the use of emergency rooms, because it drew patients who otherwise wouldn’t have gone to any medical provider. Public health was improved, but costs were not.

Whatever happens, Martin said St. Joseph Hospital knew it had to upgrade the emergency department, which was last rebuilt two decades ago.

Two of the new acute-care rooms are oversize and can hold more than one patient at a time; another room contains decontamination equipment to clean toxins off people after accidents – the old facility was outdoors, which made things tough in winter. In addition, three rooms were made more secure for patients with mental health issues, designed to increase safety for patients and staff.

Technology is everywhere; even the timepieces on the wall are atomic clocks, so everybody is synchronized.

It will be staffed by an emergency department physician on a “26-hour” schedule, meaning three shifts that overlap for two one-hour periods each day; three to eight nurses, depending on the time of day; and other clinical and support staff, including per-diem clinicians who can be called in as necessary.

No new positions have been created for the department, but decisions may change as patient traffic patterns become known.

“Depending on what happens, we will judge what we need,” Beinhaur said.

Above and beyond the treatment and medical practice improvements, working in new, modern surroundings has a psychological benefit, Martin and Beinhaur said.

“I recruited two new physicians to start this summer … and I’m sure this helped,” Martin said.

Beinhaur said that even the temporary facility produced an effect, thanks to some new equipment and the ability to experiment with different layouts and patterns.

“It really did change how patients felt, how the staff felt,” she said.

But the new emergency department will be even better.

“Everything is crisp and new,” she said. “It has been a long time coming.”

David Brooks can be reached at 594-6531 or dbrooks@nashua
telegraph.com. Also, follow Brooks on Twitter (@GraniteGeek).


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